Your 40s may bring noticeable changes in facial volume, skin firmness, pigmentation, body contours, and hair loss.
At Cosmetic Laser Dermatology in San Diego, our board-certified dermatologists create custom combination treatments designed to address these concerns while maintaining natural results.
Skin renewal gradually slows during the 40s, while cumulative sun exposure and hormonal changes may make fine lines, brown spots, redness, and uneven texture more visible. Changes in hyaluronic acid, collagen, and elastic fiber production can also contribute to early skin laxity and reduced firmness.
Facial fat and bone structure may begin to shift, creating volume loss in the cheeks, lips, temples, chin, and jawline. Some patients also experience adult acne, rosacea, melasma, thinning hair, cellulite, stubborn fat, or changes in intimate wellness.
The most effective facial rejuvenation plan often combines injectables with laser, light, and energy devices. Each treatment addresses a different aspect of aging, allowing our board-certified dermatologists to create a comprehensive plan based on facial anatomy, skin type, and recovery preferences.
Take5 is a proprietary treatment only available at Cosmetic Laser Dermatology that combines selected procedures to address several signs of aging within one coordinated visit. Depending on the patient, Take5 may improve pigmentation, redness, fine lines, skin texture, early laxity, and facial volume.
The exact combination is selected by our board-certified dermatologists according to the patient’s concerns and available recovery time.
Botox Cosmetic®, Dysport, Daxxify, Xeomin, and Jeuveau may soften expression lines caused by repeated facial movement. Treatment during the 40s may also help prevent dynamic wrinkles from becoming more established.
Neuromodulators can address forehead lines, crow’s feet, and frown lines. They may also be used for masseter slimming in appropriately selected patients. All injections are performed by our board-certified dermatologists with careful attention to natural movement and expression.
Dermal fillers can restore or enhance volume in the lips, cheeks, chin, and jawline. Options may include Skinvive, Belotero, and other hyaluronic acid fillers selected according to the patient’s anatomy and goals.
Sculptra and Radiesse are biostimulatory injectables that may gradually improve structural support and skin quality by encouraging hyaluronic acid, collagen, and elastic fiber production. Combination treatment may be recommended when patients have both volume loss and changes in skin firmness.
For under eye hallowing, our board-certified dermatologists may also consider selected dermal fillers when appropriate. Sculptra may be used strategically in surrounding areas, such as the cheeks or temples, to improve broader facial support, while dermal fillers may be considered for more direct volume correction.
IPL , Clear + Brilliant®, and 3D MIRACL® may improve sun damage, brown spots, redness, and uneven skin tone. Selected patients may include these treatments in a maintenance plan approximately every six months, depending on skin type, sun exposure, and treatment response.
PicoSure and PicoWay may be used for selected brown spots, pigmentation, and melasma concerns. Because melasma can respond unpredictably to heat and irritation, treatment often combines conservative procedures with medical grade skincare and strict sun protection.
Vbeam may be recommended for rosacea, persistent redness, and visible facial vessels. Clear + Brilliant offers a lighter option for maintaining skin texture, tone, and radiance.
Potenza RF microneedling combines controlled microneedling with radiofrequency energy. It may improve enlarged pores, uneven texture, acne scars, and early skin laxity.
The treatment supports fibroblastic function to enhance hyaluronic acid, collagen, and elastic fiber production. Settings can be adjusted according to the treatment area, skin type, and level of correction needed.
Fraxel and ResurFX may be recommended for acne scars, fine lines, sun damage, and uneven texture. UltraClear offers a more comprehensive resurfacing option for patients seeking greater improvement in visible skin damage and texture.
These laser treatments stimulate fibroblastic activity to enhance hyaluronic acid, collagen, and elastic fiber production. Acne scar plans may also include Potenza RF microneedling, subcision, fillers, or a combination of procedures.
For active adult acne, Accure or photodynamic therapy may be considered. Professional facials, peels, and medical grade skincare may also help manage breakouts and support clearer skin.
Ultherapy Prime, XERF, Thermage FLX, and Sofwave deliver focused ultrasound or radiofrequency energy at different depths. These treatments support hyaluronic acid, collagen, and elastic fiber production to improve firmness without surgery.
The best option depends on skin thickness, degree of laxity, treatment area, and previous procedures. Some patients may benefit from alternating or combining technologies within a longer-term plan.
Changes during the 40s are not limited to the face. Cosmetic Laser Dermatology offers treatments for localized fat, muscle definition, cellulite, stretch marks, scars, hair thinning, leg veins, intimate wellness concerns, and precancerous lesions.
CoolSculpting may reduce selected pockets of unwanted fat without surgery, while CoolTone uses magnetic muscle stimulation to improve definition. Cool³ combines body contouring approaches within one coordinated plan.
Liposculpture may be more appropriate when a patient wants direct fat removal and more precise contouring. ThermiRF can also be incorporated into selected body treatments to improve tissue firmness by supporting hyaluronic acid, collagen, and elastic fiber production.
Body contouring procedures are not weight loss treatments. The right approach depends on whether the primary concern is fat, muscle tone, cellulite, or skin laxity.
Cellulite treatment may involve fibrous bands, volume loss, skin laxity, and changes in surface texture. Because several factors can contribute, combination treatment is often more effective than relying on one procedure.
Ultherapy Prime, Thermage FLX, Sofwave, and XERF skin tightening may be considered when skin laxity is contributing to the concern. These laser, light, and energy technologies support fibroblastic function to enhance hyaluronic acid, collagen, and elastic fiber production.
C-section scars, surgical scars, traumatic scars, raised scars, and depressed scars require different approaches. Treatment may include fractional laser resurfacing, UltraClear, Potenza RF microneedling, subcision, or injectable support.
The objective is to improve scar color, texture, depth, and flexibility while encouraging hyaluronic acid, collagen, and elastic fiber production. Complete scar removal is not always possible, but many scars can become less noticeable.
Hair thinning in the 40s may be associated with genetics, hormonal changes, stress, nutrition, medication, or medical conditions. A professional evaluation helps identify the likely cause before treatment begins.
Hair loss treatment may include regenerative procedures, prescription therapy, topical care, or other options recommended by our board-certified dermatologists. The plan may change over time based on hair density and treatment response.
ThermiVa uses controlled radiofrequency energy to address selected intimate wellness concerns related to aging, childbirth, or hormonal changes. It may be considered for tissue laxity, dryness, or urinary leakage after an appropriate evaluation.
The treatment supports hyaluronic acid, collagen, and elastic fiber production within the treated tissue. Candidacy and expected outcomes vary for each patient.
Sclerotherapy may be recommended for spider veins and selected reticular veins. The treatment involves injecting a solution into the unwanted vein so it gradually closes and becomes less visible.
Phlebectomy may be appropriate for larger surface veins that can be removed through very small openings. The recommended method depends on vein size, location, symptoms, circulation, and medical history.
Photodynamic therapy may be used to treat actinic keratoses as well as certain types of acne. Treatment involves applying a topical photosensitizing medication before exposing the area to a controlled light source.
The treatment plan and recovery recommendations depend on the condition being addressed, the treatment area, and the patient’s skin.
TotalTat³ provides a comprehensive approach to tattoo removal, while individual laser tattoo removal sessions may be used for selected ink colors and tattoo types. Laser treatment may also improve unwanted or discolored permanent makeup.
Laser treatment may also be considered for unwanted or discolored permanent makeup, although cosmetic pigments can respond differently from traditional tattoo ink and require careful evaluation before treatment.
The 3xFacial, professional facials and peels with Farzaneh Momeni-Salami, medical grade skincare, and customized home skincare regimens can support ongoing maintenance. Daily broad-spectrum sunscreen remains essential for protecting results and reducing further sun damage.
These options may be performed independently or included within a broader facial, skin, and body treatment plan.
Cosmetic Laser Dermatology provides access to an extensive collection of injectables and laser, light, and energy devices. This range allows our board-certified dermatologists to choose the most appropriate treatment rather than relying on one technology for every concern.
Our physicians are involved in clinical research and have extensive experience combining facial rejuvenation, skin resurfacing, body contouring, scar treatments, vascular procedures, and medical dermatology. Every plan is developed with an emphasis on natural results, expert care, and long-term skin health.
We are proud to share that Dr. Goldman, Dr. Butterwick, Dr. Groff, Dr. Fabi, & Dr. Boen have once again been recognized as Castle Connolly Top Doctors in 2026!
Cosmetic Laser Dermatology has been voted Best Cosmetic Dermatology Practice in San Diego Magazine’s 2026 “Best of San Diego” readers’ poll!
Dr. William Groff was voted Best Cosmetic Dermatologist, Best Cosmetic Surgeon, and Best Dermatologist for 4 consecutive years by the San Diego Reader Best Poll.
Dr. Mitchel Goldman was voted #1 Cosmetic Dermatologist in America by Newsweek
Dr. William Groff was voted Best Cosmetic Dermatologist and Best Cosmetic Surgeon for 9 consecutive years by the San Diego U-T Best Readers Poll.
Drs. Goldman, Butterwick, and Fabi made the top 8 in Newsweek’s Best Cosmetic Dermatologists in America for the last two years in a row
Voted in the top 10% of Realself Doctors by achieving high patient satisfaction and getting favorable feedback on Q&A
Dr. William Groff was voted Best Dermatologist for 10 consecutive years and Best Cosmetic Surgeon for 9 consecutive years by the La Jolla Light Best Readers Poll.
Drs. Goldman, Butterwick, Groff, Fabi, and Boen were named Castle Connolly Top Doctors in 2025, making us one of the Top 3 Practices in California with the most Castle Connolly Top Doctors in Dermatology.
Dr. Boen has been recognized as a Top Doctor in 2023 and 2024 by San Diego County Medical Society.
Dr. Butterwick, is a distinguished facial cosmetic surgeon certified by the American Board of Facial
Cosmetic Surgery (ABFCS).
In 2026, Mitchel P. Goldman, MD, FAAD, received the Richard E. Fitzpatrick, MD Award from Masters of Aesthetics in recognition of his contributions to cosmetic dermatology and laser medicine. The honor reflects his longstanding leadership in research, physician education, and advancing aesthetic treatment.
Sabrina Fabi, MD has been named a finalist for Pioneer of the Year – Healthcare with San Diego Magazine’s Celebrating Women 2026
5/5 STARS
I trust Farzaneh Momeni completely with my skin. She is by far the best clinical aesthetician I’ve ever known. My skin has improved dramatically since I began monthly facials with her. Her treatments are 100% results-driven so if this is what you seek, look no further. Also, the entire Team at West Dermatology are top-notch. They’re always friendly, professional, & helpful, & greet everyone with a smile. 10 Stars all around!
My new regular cosmetic dermatology office. Dr Zubair is amazing and really patient with me. He has helped me over the last year with keloid scar removal, jaw Botox, and full facial acne scar treatment (ultra clear). The office is clean and the nursing/medical assistant staff is accommodating on all levels. I will always recommend this office and Dr Zubair to friends and family.
Most professional and most impressive! The service from the physicians to office staff is superb!
I live in Orange County and drove all the way out to see Dr. Wu because a friend of mine referred him (she had amazing results from her face and neck procedure). Dr. Wu is truly an artist! He made me feel extremely comfortable during my procedure. I was anxious when I got there, but he (and his staff) have such great energy and are so very kind and gentle that you can't help but feel at ease! The office was immaculate and they adhered to covid rules (sanitizing, temp checks, masks). This is my go-to place from now on and Dr. Wu is my go-to guy! Can't wait to see my final results! Thank you Phyllis (pre-op) for being so wonderful and informative! You were so very helpful and kind! I'll definitely be back!
Leysin and the entire team at Cosmetic Laser Dermatology are fantastic. They are professional, caring and communicative. The laser treatment was comfortable, efficient and effective! I highly recommend this practice. I definitely will come back and recommend her and Cosmetic Laser Dermatology to my family and friends.
Dr. Goldman is amazing! I came here for my permanent eyeliner removal (which is not offered anywhere near me), and they are completely removed in just one session. They use a special contact lens to protect your eyes from the laser, and there are no damages to my eyelashes. The healing was also nice and smooth. They have everything you need. I live almost 3 hours away, but it was totally worth the trip. For anyone who is looking to remove their permanent makeup, this is the right place to go :)-
Dr. Butterwick is fantastic, all of her team as well. They make sure your experience is pleasant and painless as possible. My tattoo removal and my injectables look amazing. I highly recommend her for any skin treatment.
Cosmetic Laser Dermatology was recommended to me by my dermatologist. He recommended Dr. Monica Boen. I'm so glad I took his recommendation. Everyone here at Cosmetic Laser Dermatology was super nice and friendly. Very welcoming. I came here for hair removal treatment. I did 4 sessions with Dr. Boen. Dr. Boen made me feel so comfortable and at ease when I talked to her. She explained everything before she did my treatment. I loved that. She was really easy to talk to. I definitely will come back and recommend her and Cosmetic Laser Dermatology to my family and friends.
This office is awesome. My visit today was with Dr. Groff. His bed side manner is so fun and welcoming. He understood my concerns and recommended a treatment plan that I feel was reasonable. I love his staff! They take there time to make sure you understand the treatment and after care. Everyone in the office, from the front desk to the nurses in the back, are so friendly and beautiful. They are very prompt and I trust my care with CLD. I can't wait for my next visit. See you guys in a few weeks!
"Dr. Sabrina Fabi is genius! Her technique is unlike anyone, her eye is precise, and her kindness and caring manner comes from the depth of her soul. She's simply brilliant! It's no wonder people travel the country just to be treated by her."
I wish I could give them 10 stars! I had such an awesome experience for my first visit and I am referring everyone I know to this office. From the super friendly staff to the state of the art procedures, they are the cream of the crop.
“I came to participate in a research study. All of the Doctors and staff at C.L. Dermatology are very professional, warm and friendly. All our my needs were anticipated and the hospitality of this office is like a five star hotel.”
The right treatment depends on the location and degree of laxity. Ultherapy Prime, Thermage FLX, Sofwave, XERF skin tightening, Potenza RF microneedling, or ThermiSculpt³ may be considered depending on the patient’s anatomy and goals. These treatments support fibroblastic function to enhance hyaluronic acid, collagen, and elastic fiber production.
Neuromodulators may reduce repeated muscle movement that contributes to expression lines. Sunscreen, medical grade skincare, and consistent laser, light, and energy maintenance may also help limit visible sun damage.
Selected patients may schedule IPL approximately every six months for recurring pigmentation or redness. Frequency depends on skin type, sun exposure, treatment response, and seasonal timing.
Accure, photodynamic therapy, medical grade skincare, professional peels, and facials may be considered. Active breakouts should usually be controlled before or alongside acne scar treatment.
Fraxel, ResurFX, UltraClear, Potenza RF microneedling, subcision, and fillers may be combined based on scar type. These procedures encourage hyaluronic acid, collagen, and elastic fiber production.
CoolSculpting targets selected fat pockets, while CoolTone focuses on muscle stimulation. Cool³ combines body contouring methods based on the patient’s anatomy and goals.
Both may be addressed within one treatment plan when appropriate. Fractional lasers, Potenza RF microneedling, and subcision may improve texture and support hyaluronic acid, collagen, and elastic fiber production.
ThermiVa may be considered for selected changes associated with childbirth, aging, or hormonal shifts. A consultation is necessary to determine candidacy.
Routine examinations are important, particularly for patients with extensive sun exposure, numerous moles, or a personal or family history of skin cancer. New, changing, bleeding, or non-healing lesions should be evaluated promptly.
Combination treatment is often appropriate because wrinkles, pigmentation, volume loss, scars, redness, and laxity have different causes. Our board-certified dermatologists may combine injectables, skincare, and laser, light, and energy devices within one coordinated plan.
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